chapter 23, 24 notes Flashcards
preoperative fluid balance
adh released during surgery curtails the ability of the kidneys to remove excess fluid
patients are replaced during surgery to compensate for surgical losses as well as hourly fluid requirements
third spacing- lack of fluid in the extracellular space- going to a third space.
crystalloids
cross rapidly from the vascular to the interstitial spaces (gut, lungs, dependent parts)
ONLY 1/3 REMAIN INTRAVASCULAR
Balanced salt solutions
LR, plasma-lyte, normosol
lactate is metabolized to generate bicarbonate
fluids to be used with blood
saline or plasma lyte
normal saline
dose dependent- hyperchloremic metabolic acidosis, and need for renal replacement therapy
hypertonic saline
used to control intracranial hypertension or rapid intravascular resuscitation
5% dextrose
similar to free water as dextrose is metabolized- not commonly seen in the or as hyperglycemia is associated with poor outcomes and the stress of the operative period causes blood sugar levels to increase
albumin
5%-25% solution compromised of 50% plasma proteins it remains in the intravascular space longer than crystalloids.
dextran 40&70
reduce factor VIII-Ag von willebrand factor. and hence platelet function.
potent osmotic agent used to treat hypovolemia. degraded to glucose increased bleeding times and noncardiogenic pulmonary edema.
hydroxyethyl starch
interferes with von willebrand factor VIII and platelet function. most common complication is pruritus. black box- do not use in ICU or sepsis
crystalloids versus colloids
SAFE (surviving sepsis campaign) stated crystalloids initially albumin when patient requires substantial amounts of crystalloids- yet one study stated mortality was higher with albumin.
young women with short gynelocigcal surgery
20-30ml/kg associated with less nausea and vomiting and improved pain control
maintenance fluid formula
first 10kg- 4ml/kg
second 10 gets 2ml/kg
each kg after gets 1ml/kg
three theories of fluid need
surface area can estimate water expenditure
calorie need depend on age, weight, activity, and food
urinary output and insensible losses correspond to age
d5 1/2 normal saline
hypertonic 432
d5ns
hypertonic 586
lr
iso 273
d5LR
hypertonic 525
1/2 ns
hypotonic 154
3% saline
hypertonic 1026
5% saline
hypertonic 1710
7.5% saline
hypertonic 1786
plasmalyte
isotonic 294
blood storage
some specialities require “younger blood” less than 14 days old to be transfused. yet there is not sufficient data to state that blood storage duration has an increased mortality rate.
monitoring for blood loss
gauze, floor, pockets on the drapes, suction containers, also accounting for the fluid to wash out wound.
monitoring for inadequate perfusion
cvp, bp, urine, tachycardia, arterial ph will decrease only when tissue hypo perfusion becomes severe.
blood administration
treat anemia with iron and erythropoietin preop. only give when absolutely necessary.
hgb less than 6 almost always require blood transfusion.
conditions such as cad, lung disease, surgery associated with large blood loss may warrant transfusion at a higher threshold.
decision to administer
based on measured blood loss and inadequate oxygen carrying capacity
platelets
during surgery platelet are not required unless the count is less than 50,000cells/mm
platelet related sepsis
1:5000 if fever develops 4-6hrs after transfusion treat for sepsis
stored at 20-24C and account for greater degree of bacteria growth.
ffp-
reversal of warfarin and management of heparin resistance
cryoprecipitate
treating hemophillia
leading causes of a fatal outcomes from blood tranfusions
TRALI
TACO
TRALI
lung injury to include pulmonary edema, arterial hypoxemia, dyspnea. less often in blood less than 14 days in storage and exclusion of female donors.
citrate
hypocalcemia is seen in liver transplant patients or patient receiving mass transfusion
febrile reactions
1% occurrence. interaction between recipient antibodies and antigens present on the leukocytes or platelet of the donor. slow infusion and administer antipyretics. temp doesn’t increase above 38
D5%
hypotonic 253
ns
iso 308
d51/4ns
iso 355
